Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Massachusetts program

Child coverage above the MassHealth line (Family Assistance)

Child health coverage above the free MassHealth line [Family Assistance], with premiums that depend on income.

What it is

Child health coverage above the free MassHealth line [Family Assistance], with premiums that depend on income.

Family Assistance is the next coverage door when income is too high for Standard. The same application checks both. Existing work insurance can lead to help with its premium instead of ruling your child out.

Eligibility rules
  • Children must live in Massachusetts and be under 19. The band extends above Standard to 300% of poverty. Babies are screened against their higher Standard limit first.
  • The March 2026 monthly upper limits are: 2 people $5,410; 3 $6,830; 4 $8,250; 5 $9,670; 6 $11,090.
  • An offer of work insurance is not a bar. Enrollment in a plan also does not by itself prevent Family Assistance.
What you get
  • Child health coverage with a monthly premium based on income.
  • Possible help toward a qualifying work plan’s premium.
What the help covers
  • Children under one are exempt from premiums under the premium rule.
  • MassHealth checks how existing work insurance affects direct coverage or Premium Assistance. An employer offer or enrollment does not automatically rule your child out.
  • MassHealth uses the current premium schedule and family-billing rules. Children under one are exempt, and hardship relief may reduce or waive a premium. The counselor can obtain the written monthly amount, family maximum and first billing month.
If you decide to apply
  1. Ask the hospital financial counselor to complete the MassHealth application with you and check both child coverage routes.
  2. Have current household income, your child’s identification and Social Security number, and any work-plan benefit summary ready.
  3. Ask for the premium quote and how the coverage works with your child’s cancer team before deciding.

MassHealth, on the same application as Standard: 1-800-841-2900 · Official page ↗

After you ask
  • The application notice and MassHealth can identify the decision deadline for your route. The counselor can ask about missing information, temporary coverage and urgent care while you wait.
  • The written decision identifies the coverage type and any monthly premium.
  • Ordinary premium billing begins in the month after the eligibility decision. Mixed coverage and family-billing adjustments can change the charge.
Good to know

The Children’s Medical Security Plan is a different, thinner program. Its primary and preventive care does not replace cancer coverage.

Other details
  • Premiums increased 10% on January 1, 2026. The next annual adjustment starts in March 2027, so the written quote should match the coverage period.
  • CommonHealth is a separate disability route for a child who cannot get Standard.
  • A family never pays more than three children’s premiums. Ask MassHealth for the written family amount before deciding.

Federal background: Children’s Health Insurance Program (CHIP).

Official sources
Ask your social worker

“If Standard does not fit, would Family Assistance help our child? Could we compare the premium, treatment access and work-plan help, and could you help us apply if it is worthwhile?”

Why I’m asking: I want to compare the actual monthly cost with the care and bills it would cover.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File the application, answer the questions about any employer plan, and ask for the premium in writing.

Your social worker

The hospital financial counsellor or a certified assister can file with you and chase the decision.

The care team

Records and letters when the application asks for them.

Who decides
MassHealth decides the coverage type on one application and bills the premium monthly.
Ask your social worker
“We are above the Standard line. Can you screen my child for Family Assistance, tell me what the monthly premium is, and check whether MassHealth would pay toward our work plan instead?”

How to apply

First step: File the one MassHealth application and ask what the monthly premium would be for your income before the first bill arrives.

  1. File one MassHealth application; it is screened for Standard first and this band next.
  2. Ask what the monthly premium will be and whether an employer plan can be paid for instead.
  3. Check the hospital and oncology group are in the plan you pick.

Official application / program page ↗

Where it starts: The same MassHealth application decides Standard first and Family Assistance next. Ask for the premium amount in writing before the first bill.

What to gather

  • This month’s income for the tax household
  • Insurance cards and the work plan’s summary of benefits
  • Child’s ID and Social Security number

How long: MassHealth has 60 days where Family Assistance is in play.

What a yes looks like

A notice naming Family Assistance as the coverage type, a plan choice, and a monthly premium bill.

What a no looks like, and the next move

If the no is about income being too high, ask for CommonHealth by name in the same application.

Watch out

  • Being offered or enrolled in a work plan does not bar this coverage; say so if anyone tells you otherwise.
  • MassHealth raised premium billing by 10% on January 1, 2026, so an old price list you find online will be wrong.
  • The Children’s Medical Security Plan is a different, thinner programme for uninsured children: primary and preventive care, not cancer treatment.

Dates that change this

2026-01-01: MassHealth raised monthly premium billing by 10% on January 1, 2026 and starts annual adjustments in March 2027. The current price list could not be read, so no premium dollar figure is printed here.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Child coverage from the Standard line up to three times the poverty level: $8,250 a month for four people, $6,830 for three. A monthly premium applies on a sliding scale; the current price was not published.

  • $8,250/month — Upper edge of the child band, household of 4 (300% of poverty)
  • $6,830/month — Upper edge of the child band, household of 3
  • $5,410/month — Upper edge of the child band, household of 2
  • $9,670/month — Upper edge of the child band, household of 5
  • $11,090/month — Upper edge of the child band, household of 6
  • $10 — Premium billing increase applied on January 1, 2026

Covers: The MassHealth benefit set for a child in this coverage type · Help paying an employer plan’s premium where the plan meets the state test

Legal protection: An employer offer is not a bar, and a plan that fails the premium-assistance test does not end the coverage · Children younger than one are exempt from premiums in the rule

What it costs the family: A monthly premium on a sliding scale. The current price list could not be read, so the amount here is unknown; ask MassHealth what your bill would be.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MassHealth MAGI household above 150% and at or below 300% of poverty (130 CMR 505.005); the infant Standard line takes precedence
Insurance status condition
an employer offer is not a bar; a child enrolled in a qualifying plan can be helped with the premium
Residency
Massachusetts
Premiums
sliding scale; billing rose 10% on 2026-01-01 and current prices were not published
Processing standard
60 days where Family Assistance is in play (130 CMR 502.005)

The trap: An offer of employer insurance is not a bar and being enrolled is not a bar either: the rule says a child with a plan that meets the premium-assistance test stays covered, and a child whose plan fails that test still keeps Family Assistance.

Where I read this

← Back to your options